Healthcare Provider Details

I. General information

NPI: 1720641368
Provider Name (Legal Business Name): VICTOR MICHAEL RENDON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax: 302-320-2121
Mailing address:
  • Phone: 302-320-2100
  • Fax: 302-320-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC2-0024164
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: